Since it was first described in 1978 the abdominal cocoon continues to be a rare cause of intestinal obstruction. So far this rare condition where the small intestine is encased in a fibrous membrane has been reported only in females. Diagnosis is usually made at laparotomy and the treatment of choice is lysis of adhesions. Proper recognition of this benign condition will result in the correct management of it and prevent unnecessary bowel resections. Five new cases including one male patient, together with a review of previous reports in the English literature, are presented.
Crohn's disease is extremely rare among Asians. Resection of strictures causing obstruction has traditionally been the accepted choice in surgical therapy. This may lead to problems such as iatrogenic short bowel syndrome and its sequelae. Stricturoplasty is an acceptable and safe alternative. We report a case where combined stricturoplasty and resection was performed safely and advocate its use.
Inflammatory myofibroblastic tumour is rare but more common in children. It shows an immunophenotypic features of myofibroblastic differentiation, hence bearing neoplastic potential. The diagnosis is challenging especially if it involves rectum. Surgical resection is the mainstay of treatment if clinically obstructed. A 65-year-old gentleman presented with intestinal obstruction, which then followed by a hartmann's procedure. Final diagnosis is a rare case of inflammatory myofibroblastic tumour of the rectum. We discuss its genetic involvement with a literature review.
Peritoneal anomalies are common in humans. We report the presence of a cystogastrocolic fold associated with an abnormally small gallbladder in a 50-year-old male cadaver. Presence of this fold is one of the clinically important anomalies, which can result in atrophy of the gallbladder or congenital obstruction of the duodenum.
Although bleeding into the intestinal lumen may occur in strangulating intestinal obstruction, haematemesis is infrequently encountered. We report on a patient who presented with haematemesis and who had, in addition, clinical and radiological features of small bowel obstruction. Upper gastrointestinal endoscopy did not locate the source of bleeding. At laparotomy, which was performed because of clinical deterioration, gangrenous strangulated small bowel secondary to adhesive obstruction was found. In a patient with non-resolving intestinal obstruction, a deterioration in the condition is a clear indication for exploration. Haematemesis occurring concurrently may be a marker of intestinal strangulation, adds strength to the indication and highlights the urgency of the need for exploration.